Nuclear Cardiac Stress Testing

Patients with congenital heart disease may have a nuclear cardiac stress test to evaluate how well the heart muscle is being supplied with blood and how well the ventricles are working. This test is done during exercise or with a medication that stresses the heart. The results are used to determine best alternatives for treatment.

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In a sense, nuclear testing is the opposite of X-rays. X-rays direct radiation into the body to create images; in a nuclear scan, the radiation comes from within the body to create the image. Trace amounts of thallium, a substance that emits gamma radiation, are injected into the bloodstream, usually through an IV in the arm. The thallium travels in the blood through the arteries and veins of the heart muscle. A camera that detects gamma radiation is used to create images of the heart that are interpreted by nuclear medicine specialists.

Preparing for the test includes some dietary restrictions, including avoiding caffeine for 24 hours before the test. You should wear comfortable clothing and shoes. The test can last two to four hours and begins with the insertion of an IV line for administering the thallium and attaching electrodes to the skin for an ECG. During the test, two sets of images are captured; one at rest, and the other when the heart is stressed. Each set of images takes about 20 minutes to complete and requires the patient to lie as still as possible while the gamma camera rotates about the chest.

Thallium stress tests rely on either exercise -- treadmill or stationary bicycle -- or medication to stress the heart. Several medications can be used to increase the workload to the heart; talk to your healthcare provider about the best medication for you. The most common side effects from the medication are feeling flushed and feeling that your heart is beating faster and harder.

All stress tests carry a small risk because they involve increasing the workload of the heart. The chances of suffering heart problems during the test are remote and the healthcare professionals administering the test are trained to diagnose and treat the complications appropriately and quickly. A thallium stress test involves only a small dose of radiation and poses no greater radiation exposure risk than a conventional X-ray.